Endocrine Unit, Department of Clinical Physiopathology, Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies (DENOThe), University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
J Endocrinol Invest. 2010 Jul-Aug;33(7):455-60. doi: 10.1007/BF03346624. Epub 2009 Dec 1.
Radiotherapy may be used as an adjuvant treatment of pituitary adenomas. The aim of our study was to present our experience of multimodal treatment of pituitary adenomas, consisting in temporary implantation of (192)Ir-labeled wires following transphenoidal surgery.
An observational investigation was performed on a series of 80 patients undergoing surgery (S) for pituitary adenomas between 1982 and 2000, some of whom received post-operative external beam radiotherapy (EBRT) (no.=19 between 1982 and 1990), brachytherapy (B) (no.=35, all after 1991), or both irradiation modalities (EBRT+B) (no.=14). The different treatments were compared in terms of hormonal normalization in the subgroup of patients with hypersecreting adenomas, tumor control, and side effects.
Hormonal normalization was obtained in 84% of S+B patients and in 61% of S+EBRT patients. Tumor control was obtained in 74.3% of S+B patients and in 63.1% of S+EBRT patients. Anterior pituitary hormones deficits ranged from 8.6-34% in S+B patients and from 15.8-47.4% in S+EBRT patients, after a mean follow-up of 14 yr. The latter group also showed a higher rate of multiple deficits (42.1% vs 22.8%). Diabetes insipidus and other major complications were rare events in all groups.
We presented one original experience regarding brachytherapy in the management of pituitary tumors, which turned out to be effective and safe. Additional prospective, and possibly randomized, studies should clarify whether in the era of 3-dimensional conformal radiotherapy and stereotactic radiotherapy this treatment modality may still have a role.
放射治疗可作为垂体腺瘤的辅助治疗方法。本研究旨在介绍我们经蝶窦手术后采用（192）Ir 标记线进行暂时植入的垂体腺瘤多模式治疗经验。
对 1982 年至 2000 年间接受垂体腺瘤手术（S）的 80 例患者进行了一项观察性研究，其中一些患者接受了术后外照射放疗（EBRT）（1982 年至 1990 年期间无=19）、近距离放疗（B）（所有患者均在 1991 年后接受 B）或两种放疗方式（EBRT+B）（无=14）。在伴有激素分泌过多的腺瘤亚组患者中，比较了不同治疗方法的激素正常化、肿瘤控制和副作用。
S+B 患者中 84%达到激素正常化，S+EBRT 患者中 61%达到激素正常化。S+B 患者肿瘤控制率为 74.3%，S+EBRT 患者为 63.1%。S+B 患者的前垂体激素缺乏率为 8.6%-34%，S+EBRT 患者为 15.8%-47.4%，平均随访时间为 14 年。后者组还表现出更高的多种缺陷发生率（42.1%对 22.8%）。所有组中尿崩症和其他主要并发症均为罕见事件。
我们介绍了一项关于垂体肿瘤近距离放疗管理的原始经验，结果表明该方法有效且安全。需要进一步开展前瞻性、可能是随机的研究，以明确在 3D 适形放疗和立体定向放疗时代，这种治疗方法是否仍具有作用。
